Provider Demographics
NPI:1952468480
Name:BLUM, CYNTHIA LOUISE (MS LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:BLUM
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-0801
Mailing Address - Country:US
Mailing Address - Phone:909-795-6568
Mailing Address - Fax:
Practice Address - Street 1:1007 CALIMESA BLVD
Practice Address - Street 2:SUITE D-D
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1131
Practice Address - Country:US
Practice Address - Phone:951-533-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA348359OtherMHN